Diversity in HIV epidemic transitions in India: An application of HIV epidemiological metrices and benchmarks

Abstract

Background: The Joint United Nations Programme on AIDS (UNAIDS) has emphasized on the incidence-prevalence ratio (IPR) and incidence-mortality ratio (IMR) to measure the progress in HIV epidemic control. In this paper, we describe the status of epidemic control in India and in various states in terms of UNAIDS's recommended metrices.

Method: The National AIDS Control Programme (NACP) of India spearheads work on mathematical modelling to estimate HIV burden based on periodically conducted sentinel surveillance for providing guidance to program implementation and policymaking. Using the results of the latest round of HIV Estimations in 2019, IPR and IMR were calculated.

Results: National level IPR was 0.029 [0.022-0.037] in 2019 and ranged from 0.01 to 0.15 in various States and Union Territories (UTs). Corresponding Incidence-Mortality Ratio was at 0.881 [0.754-1.014] nationally and ranged between 0.20 and 12.90 across the States/UTs.

Conclusions: Based on UNAIDS recommended indicators for HIV epidemic control, namely IPR and IMR; national AIDS response in India appears on track. However, the program success is not uniform and significant heterogeneity as well as expanding epidemic was observed at the level of States or UTs. Reinforcing States/UTs specific and focused HIV prevention, testing and treatment initiatives may help in the attainment of 2030 Sustainable Development Goals of ending AIDS as a public health threat by 2030.

Fig 1. Annual new HIV infections, annual all-cause mortality among PLHIV and total number of PLHIV by select States in India, 1990–2019.

The years (1990–2019) are reflected on X-axis; number of new infections (in 1000s) and total deaths and PLHIV (in 1000s) are on primary Y-axis while total number of PLHIV (in 1000s) is on secondary Y-axis. Orange line depicts new infections, grey line depicts total deaths among PLHIV, and blue line represents total PLHIV size.

Fig 2. Incidence-prevalence ratio by States in India, 2000–2019.

The years (2000–2019) are reflected on X-axis while IPR is on Y-axis. The highest bound on Y-axis is 0.250 for all except for Gujarat, Haryana, Madhya Pradesh, Meghalaya, Mizoram, Nagaland, Odisha and Punjab (0.500). Green line depicts target values of IPR for epidemic control, blue line represents point estimate and light blue shaded areas represents the uncertainty bounds for IPR of India/State for the period 2000–2019.

Fig 3. Incidence-mortality ratio by States in India, 2000–2019.

The years (2000–2019) are reflected on X-axis while IMR is on Y-axis. The highest bound on Y-axis is 5.000 for all except for Andhra Pradesh (7.000), Bihar (6.000), Delhi (6.000), Gujarat (12.000), Haryana (14.000), Meghalaya (12.000), Madhya Pradesh (14.000), Mizoram (45.000), Nagaland (14.000), Odisha (12.000) and Punjab (14.000). Green line depicts target value of IMR for epidemic control, blue line represents point estimate and light blue shaded areas represents the uncertainty bounds for IMR of India/State for the period 2000–2019.